When a claim is created, the system performs a number of error checks. One of those checks is a verification that the service codes you are using are valid CPT codes. Some payers (i.e. Auto and Worker's Comp) still use older codes, so you need to tell the system that those service codes are valid for that specific payer.
Adding Codes for an Insurance Company
- Navigate to Billing > Insurance List.
- Locate the insurance company desired and select Info & Settings. Use the search field if needed.
- On the Insurance Company Settings window, select the Advanced tab.
- Under the Service Codes (Non CPT Codes) section, click Add Code.
- Enter the code expired/custom code (i.e. 97001) and click Add. You will now be able to submit claims with this code.
By adding an expired/custom code, you will be bypassing the system's built-in validity check for the added codes. Make sure you are entering a service code that the insurance company considers valid or it may result in a rejection and delay payment.
When submitting electronically, your claims go through an error check with the clearinghouse before reaching the payer. If the payer considers the code to be valid, but the clearinghouse does not, it will be rejected. You would then have to submit those claims as Print & Mail.